Thank you for participating in this survey

The purpose of this survey is to generate a statewide OB cardiology referral list to support providers and hospitals with timely and appropriate consultations & referrals for pregnant and post-partum patients with or at risk for, cardiac conditions.

Between the years 2012 and 2017, there were 199 pregnancy-related deaths and 31% (N=62) were determined to be caused by a cardiac condition. These deaths were further analyzed by timing of death in relation to pregnancy demonstrating a majority of cardiac related deaths occurred during the postpartum period.

The GA Perinatal Quality Collaborative in partnership with the GA Regional Perinatal Centers, will support implementation of the AIM Cardiac Conditions in Obstetrical Care (CCOC) patient safety bundle which includes establishing coordination of appropriate consultation, co-management and/or transfer to appropriate level of maternal or newborn care. With your help, we can collect a robust statewide resource ensuring maternal patients with or at risk for cardiac conditions, receive timely and appropriate consultations & referrals to prevent morbidity and mortality.

*Survey questions may require information from your facility’s Cardiology referral network, so we have attached questions for your review prior to completing the survey.

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* 1. Hospital

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* 2. Name & Title of Person Completing This Survey

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* 3. Email for person completing this survey

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* 4. Hospital Perinatal Region

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* 5. Hospital County

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* 6. What is Your Perinatal Level of Care (through your Certificate of Need)?

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* 7. Does your hospital participate in the Georgia Perinatal Quality Collaborative (GaPQC)?

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